Healthcare Provider Details

I. General information

NPI: 1689865966
Provider Name (Legal Business Name): MOBILE THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 01/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 S CAROL MALONE BLVD
GRAYSON KY
41143-1352
US

IV. Provider business mailing address

144 S CAROL MALONE BLVD
GRAYSON KY
41143-1352
US

V. Phone/Fax

Practice location:
  • Phone: 606-474-7649
  • Fax: 606-474-0855
Mailing address:
  • Phone: 606-474-7649
  • Fax: 606-474-0855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number002054
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberKY-R2263
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberKY-1422
License Number StateKY

VIII. Authorized Official

Name: DR. ERIC TARR
Title or Position: PRESIDENT/PHYSICAL THERAPIST
Credential: DPT, OCS
Phone: 606-474-7649